2013年-世界发展银行全球_The_Economic_Burden_of_Cancers_on_Indian_Households_10页_223kb

Summary of "The Economic Burden of Cancers on Indian Households"

Core Content

This study examines the economic burden of cancer on Indian households using data from a nationally representative health and morbidity survey conducted in 2004 by the National Sample Survey Organization (NSSO). It focuses on households with at least one member diagnosed with cancer, referred to as "cancer-affected households," and compares them with control households that have similar socioeconomic and demographic characteristics.

The analysis considers several key dimensions of the economic burden, including:

• Healthcare utilization and expenditures: Outpatient and inpatient visits, out-of-pocket (OOP) spending, and overall healthcare costs.
• Non-medical consumption: Spending on goods and services outside of healthcare.
• Financing of healthcare: Use of borrowing and asset sales to cover OOP costs.
• Workforce participation: Impact on employment rates of adults and children in the household.
• Socioeconomic status (SES) subgroup analysis: How the burden differs across high and low SES households.

Main Findings

Healthcare Utilization and Expenditure

• Cancer-affected households had higher outpatient visits and more hospital admissions compared to control households.
• On average, cancer-affected households spent INR 66 to 85 more per member on outpatient care in the 15 days preceding the survey than controls.
• Annual inpatient care costs for cancer-affected households were 36% to 44% of the annual household expenditures of matched controls.
• Members without cancer in cancer-affected households had lower healthcare use and spending compared to members in control households.

Non-Medical Consumption

• Cancer-affected households had lower non-medical consumption than matched controls, with the difference ranging from INR 27 to 85 per member in the 15-day reference period.
• The reduction in non-medical spending was statistically significant for low SES households, but not always for high SES households.

Healthcare Financing

• Cancer-affected households were more likely to borrow funds or sell assets to cover healthcare costs.
• 51.40% of cancer-affected households reported borrowing or selling assets for inpatient care, compared to 15.77% of control households.
• 6.46% of cancer-affected households reported borrowing or selling assets for outpatient care, compared to 3.11% of control households.

Workforce Participation

• Adult workforce participation in cancer-affected households was 2.4% to 3.2% lower than in control households.
• Children aged 5–14 years had no statistically significant difference in workforce participation.
• When excluding the cancer patient, adults in cancer-affected households had higher workforce participation than those in control households, though the difference was not statistically significant.

Implications for Non-Cancer Household Members

• Non-cancer members in cancer-affected households experienced reduced healthcare use and lower spending on both inpatient and outpatient care.
• This suggests that the burden of cancer affects not only the patient but also other household members through financial strain and changes in labor force participation.

Key Information

• The study used propensity score matching (PSM) to control for confounding variables and ensure a fair comparison between cancer-affected and control households.
• 1,645 households were selected for analysis after matching.
• Out-of-pocket health expenditures are the primary financial burden for Indian households, due to limited public health funding (0.9%–1.2% of GDP) and insufficient insurance coverage.
• Cancer incidence is rising in India due to changing lifestyles, tobacco use, and aging population.
• The study highlights the significant economic impact of cancer, particularly on household finances and labor participation.
• High SES households experienced greater increases in healthcare spending and lower outpatient use among non-cancer members compared to low SES households.

Methodology Overview

• The study employed propensity score matching to match cancer-affected households with control households based on socioeconomic and demographic indicators.
• Matching variables included: rural/urban status, age distribution, education level of the household head, caste, religion, and insurance coverage.
• Robustness checks were conducted using alternative matching methods (nearest neighbor and stratification), excluding high-cost outliers, and adjusting for hospitalization in propensity score models.
• Subgroup analysis was performed based on the educational attainment of the household head to assess differences in economic burden across SES groups.

Conclusion

• Cancer imposes a significant economic burden on Indian households, particularly through out-of-pocket health expenditures, reduced workforce participation, and increased reliance on borrowing or asset sales.
• The burden is more pronounced in low SES households, which face greater financial strain and higher non-medical consumption reduction.
• This study is the first systematic analysis of the economic burden of cancer on households in a developing country, providing valuable insights for health policy and financial protection strategies in India.